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Blanchette-Carrière C, Montplaisir J, Boucetta S, Desautels A, Zadra A. Differential effects of sleep deprivation on sleepwalking: Role of demographic and clinical profiles. Sleep Med 2024; 121:144-150. [PMID: 38972128 DOI: 10.1016/j.sleep.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/29/2024] [Accepted: 06/16/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Although sleepwalking is one of the most prevalent and potentially injurious of the NREM parasomnias, it is still diagnosed primarily based on the patient's clinical history. Early pilot work suggested that sleep deprivation protocols could help obtain a polysomnographically-based (PSG) diagnosis of sleepwalking, but larger studies remain lacking. METHODS We compared baseline PSG recordings with those obtained after 25hrs of sleep deprivation in a cohort of 124 consecutively assessed adult sleepwalkers. RESULTS When compared to baseline recordings, post-sleep deprivation PSG assessments resulted in nearly twice as many somnambulistic episodes being recorded in the laboratory and significantly increased the proportion of patients (from 48 % to 63 %) experiencing at least one lab-based episode. Moreover, while 17 % of patients experienced a sleepwalking event exclusively during recovery sleep, only 2 % of patients did so solely at baseline. Sleep deprivation had similar facilitating effects on patents' somnambulistic events regardless of age of onset and positive versus negative family history for sleepwalking. Younger age and higher home episode frequency both predicted a positive response to sleep deprivation. A separate group of 17 patients with comorbid sleep disorders showed a similar increase in their proportion experiencing at least one episode during recovery sleep. CONCLUSION The results from this large series of sleepwalkers provide strong support for the use of sleep deprivation in facilitating the occurrence of somnambulistic events in the sleep laboratory.
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Affiliation(s)
- C Blanchette-Carrière
- Department of Psychology, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada; Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Blvd West, Montréal, Québec, H4J 1C5, Canada.
| | - J Montplaisir
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Blvd West, Montréal, Québec, H4J 1C5, Canada; Department of Psychiatry, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
| | - S Boucetta
- Neurotherapy Montreal, 1140 Beaumont Av., Montréal, Québec, H3P 3E5, Canada.
| | - A Desautels
- Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Blvd West, Montréal, Québec, H4J 1C5, Canada; Department of Neurosciences, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada.
| | - A Zadra
- Department of Psychology, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, Québec, H3C 3J7, Canada; Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Blvd West, Montréal, Québec, H4J 1C5, Canada.
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2
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Siclari F. Consciousness in non-REM-parasomnia episodes. J Sleep Res 2024:e14275. [PMID: 38952031 DOI: 10.1111/jsr.14275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
Sleepwalking and related parasomnias are thought to result from incomplete awakenings out of non-rapid eye movement (non-REM) sleep. Non-REM parasomnia behaviours have been described as unconscious and automatic, or related to vivid, dream-like conscious experiences. Similarly, some observations have suggested that patients are unresponsive during episodes, while others that they can interact with their surroundings. To better grasp and characterise the full spectrum of consciousness and environmental (dis)connection associated with behavioural episodes, 35 adult patients with non-REM sleep parasomnias were interviewed in-depth about their experiences. The level of consciousness during parasomnia episodes was reported to be variable both within and between individuals, ranging from minimal or absent consciousness and largely automatic behaviours (frequently/always present in 36% of patients) to preserved conscious experiences characterised by delusional thinking to varying degrees of specificity (65%), often about impending danger, variably formed, uni- or multisensory hallucinations (53%), impaired insight (77%), negative emotions (75%), and variable, but often pronounced, amnesia (30%). Patients described their experiences as a dream scene during which they felt awake ("awake dreaming"). The surroundings were either realistically perceived, misinterpreted (in the form of perceptual illusions or misidentifications of people), or entirely hallucinated as a function of the prevailing delusion. These observations suggest that the level of consciousness, amnesia and sensory disconnection during non-REM parasomnia episodes is variable and graded. In their full-fledged expression, non-REM parasomnia experiences feature several core features of dreams. They therefore represent a valuable model for the study of consciousness, sleep-related sensory disconnection and dreaming.
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Affiliation(s)
- Francesca Siclari
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
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3
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Cataldi J, Stephan AM, Haba-Rubio J, Siclari F. Shared EEG correlates between non-REM parasomnia experiences and dreams. Nat Commun 2024; 15:3906. [PMID: 38724511 PMCID: PMC11082195 DOI: 10.1038/s41467-024-48337-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
Sleepwalking and related parasomnias result from incomplete awakenings out of non-rapid eye movement sleep. Behavioral episodes can occur without consciousness or recollection, or in relation to dream-like experiences. To understand what accounts for these differences in consciousness and recall, here we recorded parasomnia episodes with high-density electroencephalography (EEG) and interviewed participants immediately afterward about their experiences. Compared to reports of no experience (19%), reports of conscious experience (56%) were preceded by high-amplitude EEG slow waves in anterior cortical regions and activation of posterior cortical regions, similar to previously described EEG correlates of dreaming. Recall of the content of the experience (56%), compared to no recall (25%), was associated with higher EEG activation in the right medial temporal region before movement onset. Our work suggests that the EEG correlates of parasomnia experiences are similar to those reported for dreams and may thus reflect core physiological processes involved in sleep consciousness.
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Affiliation(s)
- Jacinthe Cataldi
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
| | - Aurélie M Stephan
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - José Haba-Rubio
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
| | - Francesca Siclari
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland.
- The Sense Innovation and Research Center, Lausanne and Sion, Lausanne, Switzerland.
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands.
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4
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Castelnovo A, Schraemli M, Schenck CH, Manconi M. The parasomnia defense in sleep-related homicide: A systematic review and a critical analysis of the medical literature. Sleep Med Rev 2024; 74:101898. [PMID: 38364685 DOI: 10.1016/j.smrv.2024.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 02/18/2024]
Abstract
This review critically analyzes the forensic application of the Parasomnia Defense in homicidal incidents, drawing from medical literature on disorders of arousal (DOA) and rapid-eye-movement sleep behavior disorder (RBD). A systematic search of PubMed, Scopus, Embase, and Cochrane databases was conducted until October 16, 2022. We screened English-language articles in peer-reviewed journals discussing murders committed during sleep with a Parasomnia Defense. We followed PRISMA guidelines, extracting event details, diagnosis methods, factors influencing the acts, perpetrator behavior, timing, motives, concealment, mental experiences, victim demographics, and court verdicts. Three sleep experts evaluated each case. We selected ten homicides, four attempted homicides, and one homicide/attempted homicide that met inclusion/exclusion criteria. Most cases were suspected DOA as unanimously confirmed by experts. RBD cases were absent. Among aggressors, a minority reported dream-like experiences. Victims were primarily female family members killed in or near the bed by hands and/or with sharp objects. Objective sleep data and important crime scene details were often missing. Verdicts were ununiform. Homicides during DOA episodes, though rare, are documented, validating the Parasomnia Defense's use in forensics. RBD-related fatal aggression seems very uncommon. However, cases often lack diagnostic clarity. We propose updated guidelines to enhance future reporting and understanding of such incidents.
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Affiliation(s)
- Anna Castelnovo
- Neurocenter of Italian Switzerland, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Matthias Schraemli
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Carlos H Schenck
- Minnesota Regional Sleep Disorders Center, Departments of Psychiatry, Hennepin County Medical Center, And University of Minnesota Medical School, Minneapolis, MN, United States.
| | - Mauro Manconi
- Neurocenter of Italian Switzerland, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
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5
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Di Laudo F, Mainieri G, Provini F. Parasomnias During the COVID-19 Pandemic. Sleep Med Clin 2024; 19:177-187. [PMID: 38368064 DOI: 10.1016/j.jsmc.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
COVID-19 had a massive impact on sleep, resulting in overall increase of sleep disturbances. During lockdown many factors contributed to sleep disturbances, in particular changes in sleep-wake habits and stress. This article will describe the frequency and features of the principal parasomnias and the impact of the pandemic and the government restriction measures on sleep. Among different pathophysiological hypotheses, we will discuss the role of stress, considered as an expression of the allostatic load. Finally, during the pandemic, parasomnias were mainly investigated by questionnaires, with controversial results; video-polysomnographic studies are crucial to obtain a definitive diagnosis, even in critical conditions.
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Affiliation(s)
- Felice Di Laudo
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Via Massarenti, 9, Pad. 11, Bologna 40138, Italy
| | - Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Via Massarenti, 9, Pad. 11, Bologna 40138, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna 40139, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Via Massarenti, 9, Pad. 11, Bologna 40138, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, Bologna 40139, Italy.
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6
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Darby RR, Considine C, Weinstock R, Darby WC. Forensic neurology: a distinct subspecialty at the intersection of neurology, neuroscience and law. Nat Rev Neurol 2024; 20:183-193. [PMID: 38228905 DOI: 10.1038/s41582-023-00920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/18/2024]
Abstract
Neurological evidence is increasingly used in criminal cases to argue that a defendant is less responsible for their behaviour, is not competent to stand trial or should receive a reduced punishment for the crime. Unfortunately, neurologists are rarely involved in such cases despite having the expertise to help to inform these decisions in court. In this Perspective, we advocate for the development of 'forensic neurology', a subspecialty of neurology focused on using neurological clinical and scientific expertise to address legal questions for the criminal justice system. We review literature suggesting that the incidence of criminal behaviour is higher in people with certain neurological disorders than the general public and that undiagnosed neurological abnormalities are common in people who commit crimes. We discuss the need for forensic neurologists in criminal cases to provide an opinion on what neurological diagnoses are present, the resulting symptoms and ultimately whether the symptoms affect legal determinations such as criminal responsibility or competency.
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Affiliation(s)
- R Ryan Darby
- Department of Neurology, Division Behavioral Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Ciaran Considine
- Department of Neurology, Division Behavioral Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert Weinstock
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William C Darby
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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7
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Cordani R, Lopez R, Barateau L, Chenini S, Nobili L, Dauvilliers Y. Somnambulism. Sleep Med Clin 2024; 19:43-54. [PMID: 38368068 DOI: 10.1016/j.jsmc.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Somnambulism, also called sleepwalking, classified as a non-rapid eye movement sleep parasomnia, encompasses a range of abnormal paroxysmal behaviors, leading to sleepwalking in dissociated sleep in an altered state of consciousness with impaired judgment and configuring a kind of hierarchical continuum with confusional arousal and night terror. Despite being generally regarded as a benign condition, its potential severity entails social, personal, and even forensic consequences. This comprehensive review provides an overview on the current state of knowledge, elucidating the phenomenon of somnambulism and encompassing its clinical manifestations and diagnostic approaches.
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Affiliation(s)
- Ramona Cordani
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Regis Lopez
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Lucie Barateau
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Sofiene Chenini
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Lino Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Yves Dauvilliers
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France.
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8
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Lopez R, Dauvilliers Y. Challenges in diagnosing NREM parasomnias: Implications for future diagnostic classifications. Sleep Med Rev 2024; 73:101888. [PMID: 38150767 DOI: 10.1016/j.smrv.2023.101888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/29/2023]
Abstract
NREM parasomnias are frequent and potentially disabling sleep disorders characterized by recurrent abnormal behaviors emerging from NREM sleep. Recently, several studies provided more detailed clinical and polysomnographic characterization of NREM parasomnia which may enhance the diagnostic process. Several revisions of the diagnostic criteria have been proposed in the classification of sleep disorders, the latest being ICSD-3-TR in 2023 with no changes on NREM parasomnias since ICSD-3 published in 2014. We performed an extensive literature review to assess the evidence on the procedure of its diagnosis. We dissected the inconsistencies and shortcomings in the ICSD-3-TR to propose a revision of the current diagnostic criteria. We highlighted the limits of several clinical criteria which should rather be supportive features than mandatory criteria. Infrared cameras with video-recordings with are promising tools to precisely characterize home episodes. Sensitive and specific polysomnographic markers of NREM parasomnias have been identified and should be considered in future revisions. We also suggest the use of diagnostic specifiers (clinical subtypes, clinical significance, levels of severity, age effect, levels of certainty) to define homogeneous subgroups of patients for therapeutic intervention and research purposes. In conclusion, we advocate for significant changes in the current diagnostic criteria of NREM parasomnias for future classification.
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Affiliation(s)
- Régis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
| | - Yves Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
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9
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Halász P, Simor P, Szűcs A. Fearful arousals in sleep terrors and sleep-related hypermotor epileptic seizures may involve the salience network and the acute stress response of Cannon and Selye. Epilepsy Behav Rep 2024; 25:100650. [PMID: 38328672 PMCID: PMC10847862 DOI: 10.1016/j.ebr.2024.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
We consider the disorders of arousal and sleep-related hypermotor epilepsy as genetic twin-conditions, one without, one with epilepsy. They share an augmented arousal-activity during NREM sleep with sleep-wake dissociations, culminating in sleep terrors and sleep-related hypermotor seizures with similar symptoms. The known mutations underlying the two spectra are different, but there are multifold population-genetic-, family- and even individual (the two conditions occurring in the same person) overlaps supporting common genetic roots. In the episodes of disorders of arousal, the anterior cingulate, anterior insular and pre-frontal cortices (shown to be involved in fear- and emotion processing) are activated within a sleeping brain. These regions overlap with the seizure-onset zones of successfully operated sleep-related hypermotor seizures, and notably, belong to the salience network being consistent with its hubs. The arousal-relatedness and the similar fearful confusion occurring in sleep terrors and hypermotor seizures, make them alike acute stress-responses emerging from sleep; triggered by false alarms. The activation of the anterior cingulate, prefrontal and insular regions in the episodes of both conditions, can easily mobilize the hypothalamo-pituitary-adrenal axis (preparing fight-flight responses in wakefulness); through its direct pathways to and from the salience network. This hypothesis has never been studied.
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Affiliation(s)
- Péter Halász
- Szentágothai János Doctoral School, Semmelweis University, Budapest, Hungary
| | - Péter Simor
- Institute of Psychology, ELTE Faculty of Education and Psychology, Budapest, Hungary
| | - Anna Szűcs
- Institute of Behavioural Sciences Semmelweis University, Budapest, Hungary
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10
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Mainieri G, Loddo G, Provini F, Nobili L, Manconi M, Castelnovo A. Diagnosis and Management of NREM Sleep Parasomnias in Children and Adults. Diagnostics (Basel) 2023; 13:diagnostics13071261. [PMID: 37046480 PMCID: PMC10093221 DOI: 10.3390/diagnostics13071261] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Non-rapid eye movement (NREM) sleep parasomnias are recurrent abnormal behaviors emerging as incomplete arousals out of NREM sleep. Mounting evidence on NREM sleep parasomnias calls for an update of clinical and therapeutical strategies. In the current review, we summarize the state of the art and provide the necessary background to stimulate a critical revision of diagnostic criteria of disorders of arousal (DoA), the most common NREM sleep parasomnia. In particular, we highlight the poor sensitivity of the diagnostic items related to amnesia and absence of conscious experiences during DoA episodes, encourage the role of video-polysomnography and home-video recordings in the diagnostic and treatment work-up, and suggest three levels of diagnostic certainty based on clinical and objective findings. Furthermore, we highlight current gaps of knowledge that prevent the definition of standard guidelines and future research avenues.
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Mainieri G, Loddo G, Baldelli L, Montini A, Mondini S, Provini F. Violent and Complex Behaviors and Non-Restorative Sleep Are the Main Features of Disorders of Arousal in Adulthood: Real Picture or a More Severe Phenotype? J Clin Med 2023; 12:372. [PMID: 36615171 PMCID: PMC9821298 DOI: 10.3390/jcm12010372] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/28/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Disorders of arousal (DoA) are NREM parasomnias characterized by motor and emotional behaviors emerging from incomplete arousals from deep sleep. DoA are largely present in pediatric populations, a period during which they are labeled as self-limited manifestations. However, an extensive literature has shown that DoA can persist in adulthood, with different characteristics from childhood DoA. Adult DoA patients usually report excessive daily sleepiness, sleep-related violence during DoA episodes or potentially harmful behaviors, which are rare in childhood. The semeiological features of DoA episodes in adulthood may complicate differential diagnoses with other motor manifestations during sleep, in particular sleep-related hypermotor epilepsy. However, it cannot be excluded that adults with DoA attending sleep centers constitute a more severe phenotype, thus not being representative of adult DoA in the general population. Video-polysomnographic studies of DoA document a spectrum of motor patterns of different complexities, the simplest of which may often go unnoticed. Despite the different complexities of the episodes, neurophysiologic studies showed the co-existence of deep sleep and wakefulness during DoA episodes or even before their onset. These aspects make DoA an ideal model to investigate the mechanisms regulating local sleep, sleep arousal and cognitive functions including spatial and temporal orientation, attention or memory.
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Affiliation(s)
- Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Giuseppe Loddo
- Department of Primary Care, Azienda AUSL di Bologna, 40100 Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Angelica Montini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, 40139 Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
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12
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Abstract
Parasomnias, especially disorders of arousal during childhood, are often relatively benign and transitory and do not usually require a pharmacologic therapy. A relevant aspect in both nonrapid eye movement and rapid eye movement parasomnia treatment is to prevent sleep-related injuries by maintaining a safe environment. Physicians should always evaluate the possible presence of favoring and precipitating factors (sleep disorders and drugs). A pharmacologic treatment may be indicated in case of frequent, troublesome, or particularly dangerous events. The aim of this article is to review current available evidence on pharmacologic treatment of different forms of parasomnia.
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Affiliation(s)
- Paola Proserpio
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy.
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Raffaele Manni
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Lino Nobili
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy; Department of Neuroscience (DINOGMI), University of Genoa, Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa 5-16147, Italy
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13
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Cataldi J, Stephan AM, Marchi NA, Haba-Rubio J, Siclari F. Abnormal timing of slow wave synchronization processes in non-rapid eye movement sleep parasomnias. Sleep 2022; 45:6591470. [PMID: 35641120 DOI: 10.1093/sleep/zsac111] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/06/2022] [Indexed: 01/29/2023] Open
Abstract
STUDY OBJECTIVES Sleepwalking, confusional arousals, and sleep terrors are parasomnias occurring out of non-rapid eye movement (NREM) sleep. Several previous studies have described EEG changes associated with NREM parasomnia episodes, but it remains unclear whether these changes are specific to parasomnia episodes or whether they are part of the normal awakening process. Here we directly compared regional brain activity, measured with high-density (hd-) EEG, between parasomnia episodes and normal awakenings (without behavioral manifestations of parasomnia). METHODS Twenty adult patients with non-rapid eye movement parasomnias underwent a baseline hd-EEG recording (256 electrodes) followed by a recovery sleep recording after 25 h of total sleep deprivation, during which auditory stimuli were administered to provoke parasomnia episodes. RESULTS Both normal awakenings (n = 25) and parasomnia episodes (n = 96) were preceded by large, steep, and "K-complex-like" slow waves in frontal and central brain regions, and by a concomitant increase in high-frequency EEG (beta) activity. Compared to normal awakenings, parasomnia episodes occurred on a less activated EEG background and displayed higher slow wave activity (SWA) and lower beta activity in frontal and central brain regions after movement onset. CONCLUSIONS Our results suggest that non-rapid eye movement awakenings, irrespective of behavioral manifestations of parasomnia episodes, involve an arousal-related slow wave synchronization process that predominantly recruits frontal and central brain areas. In parasomnia episodes, this synchronization process comes into play abnormally during periods of high SWA and is associated with higher SWA after movement onset. Thus, an abnormal timing of arousal-related slow wave synchronization processes could underlie the occurrence of NREM parasomnias.
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Affiliation(s)
- Jacinthe Cataldi
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.,The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Aurélie M Stephan
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.,The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Nicola A Marchi
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - José Haba-Rubio
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Francesca Siclari
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland.,The Sense Innovation and Research Center, Lausanne and Sion, Switzerland.,Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
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14
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Poon SH, Tan WJ, Lee TS. Medicolegal aspects of non-rapid eye movement parasomnias. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:228-235. [PMID: 35506406 DOI: 10.47102/annals-acadmedsg.2021449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In a subset of adults with non-rapid eye movement (NREM) parasomnias, clinical variants might be violent in nature and can potentially result in unintentional but considerable harm. As such, there is substantial interest on the forensic ramifications of these sleep behaviours. METHODS This review examined the diagnostic criteria for parasomnias established in the context of international classification systems; medicolegal case reports; legal frameworks; and court cases in and outside of Singapore, to provide an overview of the implications of NREM parasomnias. RESULTS Violent or injurious behaviours that occurred in the context of somnambulism, otherwise known as sleepwalking, have challenged traditional legal theories of criminal culpability. Yet little has changed in the application of sleep science to criminal responsibility. In Singapore, the defence of somnambulism has hitherto not been directly raised. Nonetheless, sleep medicine practitioners may increasingly be requested to render their opinions on legal issues pertaining to violent or injurious behaviours allegedly arising during sleep. Although the understanding of NREM parasomnias has improved, there is still a dearth of evidence to support both medical and legal decisions in this area. CONCLUSION NREM parasomnias come with disquieting legal and forensic implications for adjudicating criminal responsibility. There is a need to critically examine legal perspectives on behaviours occurring during sleep. More reliable empirical studies investigating the pathophysiology of NREM parasomnias can offer clearer diagnostic guidelines and address complex behaviours of NREM that often come with medicolegal implications.
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Affiliation(s)
- Shi Hui Poon
- Neuroscience and Behavioural Disorders Programme, Duke-NUS Medical School, Singapore
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15
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Paiva T, Canas-Simião H. Sleep and violence perpetration: A review of biological and environmental substrates. J Sleep Res 2022; 31:e13547. [PMID: 35037316 DOI: 10.1111/jsr.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022]
Abstract
Violence is a worldwide societal burden that negatively impacts individual health, wellbeing and economic development. Evidence suggests a bidirectional relationship between sleep changes and violence. This review details, evaluates and discusses the biological and demographic substrates linking sleep and violence perpetration, and summarizes the overlap of brain areas, functional neuronal systems and genetic features involved, not including violent behaviours during sleep. Knowledge on the biological variables that affect the individual's susceptibility to violent behaviour may have implications for criminology, management of detentions and rehabilitation strategies.
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Affiliation(s)
- Teresa Paiva
- Sleep and Medicine Center (CENC), Comprehensive Health Research Center (CHRC), Instituto de Saúde Ambiental - Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Hugo Canas-Simião
- Psychiatry and Mental Health Department, Centro Hospitalar de Lisboa Ocidental (CHLO); Comprehensive Health Research Center (CHRC); Sleep and Medicine Center (CENC), Lisbon, Portugal
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16
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Loddo G, Fragiacomo F, Mainieri G, Mondini S, Buzzi G, Calandra-Buonaura G, Provini F. Disorders of arousal in 4 older men: evidence from clinical practice. J Clin Sleep Med 2022; 18:129-136. [PMID: 34180806 PMCID: PMC8807889 DOI: 10.5664/jcsm.9516] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To describe clinical and video-polysomnographic features of disorders of arousal (DoA) in older adults. METHODS Four consecutive male patients with nocturnal motor behaviors underwent a clinical interview, neurologic examination, laboratory tests, brain magnetic resonance imaging, and nocturnal in-laboratory or 24- to 48-hour home video polysomnography. The patients repeated an evaluation after 6 months of follow-up, including a 48-hour home video polysomnography in 2 patients. RESULTS The patients were aged 65-72 years, and 1 patient has Parkinson disease. Sleep-related behavioral episodes had begun from 12-55 years before our observation. Three patients presented with a positive family history for DoA. Sleep motor episodes were described as suddenly raising the head or trunk, sitting in bed, screaming, speaking, gesturing, and sleepwalking (in 1 patient). When questioned, all patients seemed confused, rarely reporting any dream-like content. We recorded 25 DoA episodes of different intensity and complexity arising from nonrapid eye movement sleep. The semiology of the episodes was similar to that described in younger patients, consisting of sleep terrors and confusional arousals. All patients presented with physiological rapid eye movement sleep muscle atonia. Medication therapy reduced the frequency of the episodes in 2/4 patients. CONCLUSIONS DoA may begin in adulthood and persist or arise in older adults, sometimes causing sleep-related injuries. Motor patterns of DoA in older adults are similar to those of younger patients. A combined clinical examination and video polysomnography recording are crucial in establishing a definitive diagnosis of nocturnal motor behavior in all older adults and especially in those affected by neurodegenerative diseases. CITATION Loddo G, Fragiacomo F, Mainieri G, et al. Disorders of arousal in 4 older men: evidence from clinical practice. J Clin Sleep Med. 2022;18(1):129-136.
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Affiliation(s)
| | - Federica Fragiacomo
- U.O. Neurologia, Ospedale Castelfranco Veneto, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Greta Mainieri
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Giovanna Calandra-Buonaura
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica Provini
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy,Address correspondence to: Federica Provini, MD, PhD, IRCCS, Institute of Neurological Sciences of Bologna, Bellaria Hospital, Via Altura, 3, 40139 Bologna, Italy; Tel: ++ 39 051 4966829;
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17
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Kalantari N, McDuff P, Pilon M, Desautels A, Montplaisir JY, Zadra A. Self-reported developmental changes in the frequency and characteristics of somnambulistic and sleep terror episodes in chronic sleepwalkers. Sleep Med 2021; 89:147-155. [PMID: 34990921 DOI: 10.1016/j.sleep.2021.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/10/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Far from being benign, somnambulistic episodes can be frequent and/or severe and potentially injurious. Episodes may also be accompanied by sleep mentation with variable degrees of retrograde amnesia. The present study investigated how somnambulistic episodes unfold from childhood through adulthood, a topic that remains understudied. METHODS Adult sleepwalkers with a diagnosis of primary somnambulism and a childhood onset of the disorder (n = 113) were assessed for changes in frequency of their episodes, recall of episode-related sleep mentation and aggressive episodes during childhood, adolescence and adulthood. In addition, sleepwalkers (n = 52) with childhood-onset of sleep terrors were assessed for developmental changes in sleep terror frequency. RESULTS Results indicate that the frequency of somnambulistic episodes remains unchanged during childhood and adolescence before increasing during adulthood. An opposite trend was observed for sleep terrors. The frequency of aggressive somnambulistic episodes and of sleep mentation associated with somnambulism increased from childhood to adolescence and into adulthood. By contrast, the recall of sleep mentation associated with sleep terrors did not change over time. Additionally, a higher frequency of aggressive somnambulistic episodes predicted a higher frequency of sleep mentation associated with somnambulism. These patterns were similar across men and women. CONCLUSION Our study demonstrates that in chronic sleepwalkers, sleep mentation associated with somnambulistic episodes increases with age while episodes worsen in frequency and severity from childhood to adulthood. These findings add to the limited literature in the field and provide valuable insights into how key clinical characteristics of somnambulism evolve across the lifespan.
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Affiliation(s)
- Narges Kalantari
- Centre for Advanced Research in Sleep Medicine, Hôpital Du Sacré-Coeur de Montréal, CIUSSS-NIM, Québec, Canada; Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Pierre McDuff
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada
| | - Mathieu Pilon
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Alex Desautels
- Centre for Advanced Research in Sleep Medicine, Hôpital Du Sacré-Coeur de Montréal, CIUSSS-NIM, Québec, Canada; Department of Neurosciences, Université de Montréal, Montréal, Québec, Canada
| | - Jacques-Yves Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital Du Sacré-Coeur de Montréal, CIUSSS-NIM, Québec, Canada; Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada
| | - Antonio Zadra
- Centre for Advanced Research in Sleep Medicine, Hôpital Du Sacré-Coeur de Montréal, CIUSSS-NIM, Québec, Canada; Department of Psychology, Université de Montréal, Montréal, Québec, Canada.
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18
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Gun ownership, community stress, and sleep disturbance in America. Sleep Health 2021; 8:161-166. [PMID: 34924344 DOI: 10.1016/j.sleh.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Although there is widespread speculation about guns helping people to sleep better, this idea has only recently faced empirical scrutiny. We test whether people who own guns tend to exhibit healthier sleep outcomes than people who do not own guns and whether the association between community stress and sleep is less pronounced for people who own guns. DESIGN We use ordinary least squares, multinomial logistic, and binary logistic regression to model cross-sectional survey data. SETTING Our data span the United States. PARTICIPANTS The 2021 Crime, Health, and Politics Survey (CHAPS) is based on a national probability sample of 1714 adults. MEASUREMENTS Our analyses include multiple measures of gun ownership (personal ownership, keeping a gun in one's bedroom, and COVID-19 pandemic gun purchases), community stress (neighborhood disorder, neighborhood danger during the pandemic, and perceptions of police protection), and sleep (insomnia symptoms, sleep duration, and pandemic sleep). RESULTS We found that people who own guns and people who do not own guns tend to exhibit similar sleep outcomes and that people who experience community stressors tend to exhibit similar sleep outcomes regardless of gun ownership. CONCLUSION Our analyses confirm that gun ownership is unrelated to sleep and that guns are insufficient to mitigate the detrimental effects of community stress on sleep. We extend prior work by (a) using more detailed measurements of gun ownership, community stress, and sleep, (b) assessing whether people keep a gun in their bedroom, and (c) exploring the intersection of pandemic gun purchases and pandemic sleep quality.
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19
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Morkous SS. A 16-Year-Old Male With Frequent Nocturnal Events During Slow Wave Sleep on a Polysomnogram. Cureus 2021; 13:e18047. [PMID: 34692279 PMCID: PMC8523337 DOI: 10.7759/cureus.18047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
A 16-year-old male was referred by the primary care physician (PCP) for a second opinion. An initial evaluation in another sleep center suggested a working diagnosis of night terrors for the last two years. The child would wake up frequently screaming for few minutes before going back to sleep with no recollection of these events later. A video during the polysomnography (PSG) showed the patient having one of his typical events. He was eventually diagnosed with Sleep-related Hypermotor Epilepsy (SHE) seizures. This case highlights the importance of differentiating parasomnia and seizures, particularly for the sleep medicine providers that incorporate providers from different academic backgrounds. We will discuss the clinical challenges to make the distinction for the referring providers and demonstrate the importance of video-PSG to establish the diagnosis.
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Affiliation(s)
- Sameh S Morkous
- Pediatric Neurology, Lehigh Valley Health Network (LVHN) Lehigh Valley Reilly Children's Hospital, Allentown, USA
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20
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Fujishiro H, Ota K, Yamagata M, Ito T, Hieda S, Suga H, Fukui T, Nagahama Y. Early diagnosis of prodromal dementia with Lewy bodies using clinical history of probable REM sleep behaviour disorder and cardiac 123 I-MIBG scintigraphy in memory clinics. Psychogeriatrics 2021; 21:288-295. [PMID: 33565213 DOI: 10.1111/psyg.12662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/16/2021] [Accepted: 01/23/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Rapid eye movement sleep behaviour disorder (RBD) is associated with reduced cardiac 123 I-metaiodobenzylguanidine (MIBG) uptake and often precedes the onset of Lewy body (LB) disorders. We investigated the role of cardiac 123 I-MIBG scintigraphy in relation to probable RBD for the clinical diagnosis of prodromal dementia with Lewy bodies (DLB) in memory clinics. METHODS We reviewed clinical profiles of 60 consecutive patients who underwent cardiac 123 I-MIBG scintigraphy in our memory clinics. The diagnostic threshold of 2.20 was used as the cut-off for the heart-to-mediastinum ratio at the delayed phase. RESULTS Cardiac 123 I-MIBG abnormality was identified in 28 patients at baseline; six were cognitively unimpaired, six had mild cognitive impairment (MCI)-LB, and 16 had probable DLB based on the National Institute on Aging and Alzheimer's Association Research Framework. Although the number of core features increased in accordance with the progression of three cognitive categories, there were no differences in the prevalence of probable RBD and the cardiac MIBG scintigraphy indices among them. During the observation period, two cognitively unimpaired patients with probable RBD progressed to MCI-LB, and three MCI-LB patients with probable RBD developed DLB. The prevalence of final diagnosis of probable MCI-LB or DLB was significantly higher in these patients (85%) than the remaining 32 patients without (9%). Of 25 patients with probable RBD, 22 (88%) had a cardiac 123 I-MIBG abnormality regardless of cognitive conditions. Only one patient consulted a sleep centre for the abnormal sleep behaviour before visiting our memory clinics. Regarding the gender differences, male predominance was not identified and sleep-related injury more frequently occurred in men (7/12, 58%) than in women (1/10, 10%). CONCLUSIONS Proactive detection of probable RBD plus cardiac 123 I-MIBG abnormality provides the opportunity for an early diagnosis of prodromal DLB in memory clinics. This approach warrants further follow-up studies with polysomnographic and pathological verification.
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Affiliation(s)
- Hiroshige Fujishiro
- Department of Psychiatry, Kawasaki Memorial Hospital, Kawasaki, Japan.,Department of Dementia diagnostic Centre, Yokohama Shintoshi Neurosurgery Hospital, Yokohama, Japan
| | - Kazumi Ota
- Department of Dementia diagnostic Centre, Yokohama Shintoshi Neurosurgery Hospital, Yokohama, Japan
| | - Mayumi Yamagata
- Department of Dementia diagnostic Centre, Yokohama Shintoshi Neurosurgery Hospital, Yokohama, Japan
| | - Tatsuya Ito
- Department of Neurology, Kawasaki Memorial Hospital, Kawasaki, Japan
| | - Sotaro Hieda
- Department of Neurology, Kawasaki Memorial Hospital, Kawasaki, Japan.,Department of Neurology, Showa University, Tokyo, Japan
| | - Hiroko Suga
- Department of Psychiatry, Kawasaki Memorial Hospital, Kawasaki, Japan
| | - Toshiya Fukui
- Department of Neurology, Kawasaki Memorial Hospital, Kawasaki, Japan
| | - Yasuhiro Nagahama
- Department of Neurology, Kawasaki Memorial Hospital, Kawasaki, Japan
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21
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Montini A, Loddo G, Baldelli L, Cilea R, Provini F. Sleep-Related Hypermotor Epilepsy vs Disorders of Arousal in Adults: A Step-Wise Approach to Diagnosis. Chest 2021; 160:319-329. [PMID: 33529771 DOI: 10.1016/j.chest.2021.01.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Disorders of arousal (DoA) and sleep-related hypermotor epilepsy (SHE) are sleep-related events characterized by complex, often bizarre, and violent behaviors. DoA are involuntary motor manifestations of various complexities occurring during incomplete awakening from non-rapid eye movement sleep. SHE is a focal epilepsy characterized by stereotyped hyperkinetic or/and asymmetric tonic/dystonic seizures usually arising from non-rapid eye movement sleep. Even if many aspects regarding DoA and SHE have been clarified, the differential diagnosis remains challenging, because DoA and SHE share some semiologic features and genetic background. The clinical history, collected from the patient and his/her witness, represents the first and common milestone in the diagnosis. Validated questionnaires constitute suitable screening tools that could guide further analysis. The worldwide availability of homemade video recordings has increased the possibility of adding more objective information to the clinical history alone. The confirmed diagnosis relies on video-polysomnographic recording although it requires time, economic resources, and specific skills for the analysis. In this review we propose a simple diagnostic algorithm for the differential diagnosis between DoA and SHE in adults, based on the most updated knowledge, from the simpler tool to the most specific and tailored one.
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Affiliation(s)
- Angelica Montini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Giuseppe Loddo
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Rosalia Cilea
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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22
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Loddo G, La Fauci G, Vignatelli L, Zenesini C, Cilea R, Mignani F, Cecere A, Mondini S, Baldelli L, Bisulli F, Licchetta L, Mostacci B, Guaraldi P, Giannini G, Tinuper P, Provini F. The Arousal Disorders Questionnaire: a new and effective screening tool for confusional arousals, Sleepwalking and Sleep Terrors in epilepsy and sleep disorders units. Sleep Med 2021; 80:279-285. [PMID: 33610075 DOI: 10.1016/j.sleep.2021.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arousal Disorders (DoA) include Confusional Arousals, Sleepwalking and Sleep Terrors. DoA diagnosis is mainly clinical but no validated questionnaires exist for DoA screening according to the criteria of the International Classification of Sleep Disorders, Third Edition. Recently our group proposed the Arousal Disorders Questionnaire (ADQ) as a new diagnostic tool for DoA diagnosis. The objective of this study was to evaluate the diagnostic accuracy of the ADQ in a sleep and epilepsy center. METHODS One interviewer blinded to clinical and video-polysomnographic (VPSG) data administered the ADQ to 150 patients consecutively admitted to our Sleep and Epilepsy Centers for a follow-up visit. The final diagnosis, according to VPSG recordings of at least one major episode, classified patients either with DoA (DoA group) or with other sleep-related motor behaviors confounding for DoA (nDoA group). RESULTS 47 patients (31%) composed the DoA group; 56 patients with REM sleep behavior disorder, 39 with sleep-hypermotor epilepsy, six with night eating syndrome, and two with drug-induced DoA composed the nDoA group. The ADQ had a sensitivity of 72% (95% CI: 60-82) and a specificity of 96% (95% CI: 89-98) for DoA diagnosis; excluding the items regarding consciousness and episode recall, sensitivity was 83% (95% CI: 71-90) and specificity 93% (95% CI: 86-97). CONCLUSIONS The ADQ showed good accuracy in screening patients with DoA in a sleep and epilepsy center setting. Diagnostic criteria related to cognition and episode recall reduced ADQ sensitivity, therefore a better definition of these criteria is required, especially in adults.
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Affiliation(s)
- Giuseppe Loddo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giusy La Fauci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Luca Vignatelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Rosalia Cilea
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Francesco Mignani
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Annagrazia Cecere
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Laura Licchetta
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Reference Center for Rare and Complex Epilepsies - EpiCARE, Bologna, Italy
| | - Federica Provini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
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Abstract
Patient education and behavioral management represent the first treatment approaches to the patient with parasomnia, especially in case of disorders of arousal (DOA). A pharmacologic treatment of DOA may be useful when episodes are frequent and persist despite resolution of predisposing factors, are associated with a high risk of injury, or cause significant impairment, such as excessive sleepiness. Approved drugs for DOA are still lacking. The most commonly used medications are benzodiazepines and antidepressants. The pharmacologic treatment of rapid eye movement sleep behavior disorder is symptomatic, and the most commonly used drugs are clonazepam and melatonin.
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Affiliation(s)
- Paola Proserpio
- Department of Neuroscience, Centre of Sleep Medicine, Centre for Epilepsy Surgery, Niguarda Hospital, Piazza Ospedale Maggiore, Milan 3-20162, Italy
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino, Pavia 2-27100, Italy
| | - Raffaele Manni
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino, Pavia 2-27100, Italy
| | - Lino Nobili
- Department of Neuroscience, Centre of Sleep Medicine, Centre for Epilepsy Surgery, Niguarda Hospital, Piazza Ospedale Maggiore, Milan 3-20162, Italy; Department of Neuroscience (DINOGMI), University of Genoa, Child neuropsychiatry, Gaslini Institute, Via Gerolamo Gaslini, Genoa 5-16147, Italy.
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24
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Hill TD, Dowd-Arrow B, Burdette AM, Hale L. Gun ownership and sleep disturbance. Prev Med 2020; 132:105996. [PMID: 31987978 DOI: 10.1016/j.ypmed.2020.105996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/02/2020] [Accepted: 01/21/2020] [Indexed: 11/17/2022]
Abstract
Although there is no empirical evidence linking gun ownership with better sleep, speculation is widespread in gun culture. We assess the direct association between gun ownership and sleep disturbance and whether gun ownership moderates the association between neighborhood fear and sleep disturbance. We use four waves of cross-sectional data from the General Social Survey (2010-2018) and logistic regression to model sleep disturbance as a function of gun ownership and test the statistical interaction of gun ownership and neighborhood fear. Our analyses demonstrate that gun ownership is unrelated to sleep disturbance across sleep specifications. None of the statistical interactions between gun ownership and neighborhood fear reached statistical significance. Although being afraid to walk alone at night in one's neighborhood is associated with restless sleep, owning a gun is no consolation. In ancillary analyses, we observed that gun ownership is unrelated to sleep disturbance across survey years and a range of subpopulations. In the first empirical study of gun ownership and sleep, we find consistent evidence to suggest that people who own guns do not report better sleep in general or in the context of living in a dangerous neighborhood. Our analyses are important because they contribute to our understanding of the epidemiology of sleep. They also challenge theoretical perspectives and cultural narratives about how having a gun in the home helps individuals and their families to feel safe, secure, and protected. Additional research is needed to replicate our findings using longitudinal data and more reliable measures of sleep disturbance.
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Affiliation(s)
- Terrence D Hill
- The University of Arizona, School of Sociology, Social Sciences Building, Room 427, 1145 E. South Campus Drive, Tucson, AZ 85721, USA.
| | - Benjamin Dowd-Arrow
- Florida State University, Department of Sociology, 526 Bellamy Building, Tallahassee, FL 32306-2270, USA.
| | - Amy M Burdette
- Florida State University, Department of Sociology, 526 Bellamy Building, Tallahassee, FL 32306-2270, USA.
| | - Lauren Hale
- Stony Brook University, Program in Public Health, 101 Nicolls Road, Health Sciences Center, Stony Brook, NY 11794, USA.
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25
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Loddo G, Lopez R, Cilea R, Dauvilliers Y, Provini F. Disorders of Arousal in adults: new diagnostic tools for clinical practice. SLEEP SCIENCE AND PRACTICE 2019. [DOI: 10.1186/s41606-019-0037-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Disorders of Arousal (DOA) are mental and motor behaviors arising from NREM sleep. They comprise a spectrum of manifestations of increasing intensity from confusional arousals to sleep terrors to sleepwalking.
Although DOA in childhood are usually harmless, in adulthood they are often associated with injurious or violent behaviors to the patient or others. Driving motor vehicles, suspected suicide, and even homicide or attempted homicide have been described during sleepwalking in adults. Furthermore, adult DOA need to be differentiated from other sleep disorders such as Sleep-related Hypermotor Epilepsy or REM Sleep Behavior Disorder.
Although many aspects of DOA have been clarified in the last two decades there is still a lack of objective and quantitative diagnostic criteria for DOA.
Recent advances in EEG analysis and in the semiological characterization of DOA motor patterns have provided a better definition of DOA diagnosis.
Our article focuses on the DOA diagnostic process describing accurately the newest DOA clinical, EEG and video-polysomnographic tools in order to aid clinicians in DOA assessment.
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Cramer Bornemann MA, Schenck CH, Mahowald MW. A Review of Sleep-Related Violence. Chest 2019; 155:1059-1066. [DOI: 10.1016/j.chest.2018.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 10/19/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022] Open
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Desjardins MÈ, Baril AA, Soucy JP, Dang-Vu TT, Desautels A, Petit D, Montplaisir J, Zadra A. Altered brain perfusion patterns in wakefulness and slow-wave sleep in sleepwalkers. Sleep 2019. [PMID: 29514303 DOI: 10.1093/sleep/zsy039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Study Objectives The present study assessed brain perfusion patterns with single-photon emission computed tomography (SPECT) during sleepwalkers' post-sleep deprivation slow-wave sleep (SWS) and resting-state wakefulness. Methods Following a 24 hr period of sleep deprivation, 10 sleepwalkers and 10 sex- and age-matched controls were scanned with a high-resolution SPECT scanner. Participants were injected with 99mTc-ethylene cysteinate dimer after 2 min of stable SWS within their first sleep cycle as well as during resting-state wakefulness, both after a subsequent 24 hr period of sleep deprivation. Results When compared with controls' brain perfusion patterns during both SWS and resting-state wakefulness, sleepwalkers showed reduced regional cerebral perfusion in several bilateral frontal regions, including the superior frontal, middle frontal, and medial frontal gyri. Moreover, reduced regional cerebral perfusion was also found in sleepwalkers' left postcentral gyrus, insula, and superior temporal gyrus during SWS compared with controls. During resting-state wakefulness compared with controls, reduced cerebral perfusion was also found in parietal and temporal regions of sleepwalkers' left hemisphere, whereas the right parahippocampal gyrus showed increased regional cerebral perfusion. Conclusions Our results reveal patterns of reduced regional cerebral perfusion in sleepwalkers' frontal and parietal areas when compared with controls, regions previously associated with SWS generation and episode occurrence. Additionally, reduced perfusion in the dorsolateral prefrontal cortex and insula during recovery SWS is consistent with the clinical features of somnambulistic episodes, including impaired awareness and reduced pain perception. Altered regional cerebral perfusion patterns during sleepwalkers' resting-state wakefulness may be related to daytime functional anomalies in this population.
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Affiliation(s)
- Marie-Ève Desjardins
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
| | - Andrée-Ann Baril
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Jean-Paul Soucy
- PERFORM Centre, Concordia University, Montreal, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Thien Thanh Dang-Vu
- PERFORM Centre, Concordia University, Montreal, Canada.,Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal and Department of Neurosciences, Université de Montréal, Montreal, Canada
| | - Alex Desautels
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Dominique Petit
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Antonio Zadra
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, Canada.,Department of Psychology, Université de Montréal, Montreal, Canada
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Abstract
Our understanding of non-rapid eye movement (NREM) parasomnias has improved considerably over the last two decades, with research that characterises and explores the causes of these disorders. However, our understanding is far from complete. The aim of this paper is to provide an updated review focusing on adult NREM parasomnias and highlighting new areas in NREM parasomnia research from the recent literature. We outline the prevalence, clinical characteristics, role of onset, pathophysiology, role of predisposing, priming and precipitating factors, diagnostic criteria, treatment options and medico-legal implications of adult NREM parasomnias.
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Otheman Y, Satté A, Mounach J, Kadiri M, Bichra MZ. [Sleep related dissociative disorder: A case complicated by a suicide attempt]. Encephale 2018; 45:271-273. [PMID: 29983174 DOI: 10.1016/j.encep.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 06/10/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Y Otheman
- Service de psychiatrie, hôpital militaire d'instruction Mohammed-V Hay Ryad, Rabat, Maroc.
| | - A Satté
- Service de neurophysiologie, hôpital militaire d'instruction Mohammed-V Hay Ryad, Rabat, Maroc
| | - J Mounach
- Service de neurophysiologie, hôpital militaire d'instruction Mohammed-V Hay Ryad, Rabat, Maroc
| | - M Kadiri
- Service de psychiatrie, hôpital militaire d'instruction Mohammed-V Hay Ryad, Rabat, Maroc
| | - M Z Bichra
- Service de psychiatrie, hôpital militaire d'instruction Mohammed-V Hay Ryad, Rabat, Maroc
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31
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Manni R, Toscano G, Terzaghi M. Therapeutic Symptomatic Strategies in the Parasomnias. Curr Treat Options Neurol 2018; 20:26. [DOI: 10.1007/s11940-018-0508-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Menghi V, Bisulli F, Tinuper P, Nobili L. Sleep-related hypermotor epilepsy: prevalence, impact and management strategies. Nat Sci Sleep 2018; 10:317-326. [PMID: 30349413 PMCID: PMC6186898 DOI: 10.2147/nss.s152624] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sleep-related hypermotor epilepsy (SHE), previously called nocturnal frontal lobe epilepsy (NFLE), is a focal epilepsy characterized by asymmetric tonic/dystonic posturing and/or complex hyperkinetic seizures occurring mostly during sleep. SHE fulfills the definition of rare disease with an estimated minimum prevalence of 1.8/100,000 individuals, and it represents about 10% of drug-resistant surgical cases. Although SHE and autosomal-dominant SHE (ADSHE) have been considered benign epileptic conditions for a long time, emerging data have shed light on the severity of this disorder and some peculiar features can impact negatively on the quality of life of SHE patients. In fact, seizure frequency can be very high, resulting in nocturnal sleep fragmentation with possible diurnal consequences such as excessive sleepiness and fatigue. Moreover, recent studies, adopting a systematic neuropsychological assessment, have shown deficits in memory, executive functions and visuo-spatial abilities in almost half of SHE patients. Intellectual disabilities and psychiatric disorders have also been reported in some genetic forms. SHE may also exert a negative effect on health-related quality of life, especially in domains pertaining to a patient's role in the family, social context and patient's illness experience. Despite a good response to pharmacological treatment, especially with carbamazepine, 30% of SHE patients suffer from drug-resistant seizures. Finally, recent studies suggest a poor prognosis in a high percentage of SHE patients with a 20.4% cumulative probability of achieving terminal remission at 10 years from onset. For selected drug-resistant SHE patients, epilepsy surgery is the only treatment offering high probability of recovery, both for seizures and for epilepsy-related sleep alterations.
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Affiliation(s)
- Veronica Menghi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Tinuper
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lino Nobili
- "Claudio Munari" Center for Epilepsy Surgery, Niguarda Hospital, Milan, Italy, .,Department of Neuroscience (DINOGMI), IRCCS, Giannina Gaslini Institute, University of Genoa, Genoa, Italy,
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34
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Loddo G, Sessagesimi E, Mignani F, Cirignotta F, Mondini S, Licchetta L, Bisulli F, Tinuper P, Provini F. Specific motor patterns of arousal disorders in adults: a video-polysomnographic analysis of 184 episodes. Sleep Med 2018; 41:102-109. [DOI: 10.1016/j.sleep.2017.08.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 11/27/2022]
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35
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Desjardins MÈ, Carrier J, Lina JM, Fortin M, Gosselin N, Montplaisir J, Zadra A. EEG Functional Connectivity Prior to Sleepwalking: Evidence of Interplay Between Sleep and Wakefulness. Sleep 2017; 40:2991628. [PMID: 28204773 DOI: 10.1093/sleep/zsx024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Study Objectives Although sleepwalking (somnambulism) affects up to 4% of adults, its pathophysiology remains poorly understood. Sleepwalking can be preceded by fluctuations in slow-wave sleep EEG signals, but the significance of these pre-episode changes remains unknown and methods based on EEG functional connectivity have yet to be used to better comprehend the disorder. Methods We investigated the sleep EEG of 27 adult sleepwalkers (mean age: 29 ± 7.6 years) who experienced a somnambulistic episode during slow-wave sleep. The 20-second segment of sleep EEG immediately preceding each patient's episode was compared with the 20-second segment occurring 2 minutes prior to episode onset. Results Results from spectral analyses revealed increased delta and theta spectral power in the 20 seconds preceding the episodes' onset as compared to the 20 seconds occurring 2 minutes before the episodes. The imaginary part of the coherence immediately prior to episode onset revealed (1) decreased delta EEG functional connectivity in parietal and occipital regions, (2) increased alpha connectivity over a fronto-parietal network, and (3) increased beta connectivity involving symmetric inter-hemispheric networks implicating frontotemporal, parietal and occipital areas. Conclusions Taken together, these modifications in EEG functional connectivity suggest that somnambulistic episodes are preceded by brain processes characterized by the co-existence of arousal and deep sleep.
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Affiliation(s)
- Marie-Ève Desjardins
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,Department of Psychology, Université de Montréal, Montréal, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,Department of Psychology, Université de Montréal, Montréal, Canada
| | - Jean-Marc Lina
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,École de technologie supérieure, Department of Electrical Engineering, Montréal, Canada
| | - Maxime Fortin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,Department of Psychology, Université de Montréal, Montréal, Canada
| | - Jacques Montplaisir
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,Department of Psychiatry, Université de Montréal, Montréal, Canada
| | - Antonio Zadra
- Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Cœur de Montréal, Montréal, Canada.,Department of Psychology, Université de Montréal, Montréal, Canada
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36
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Haba-Rubio J, Frauscher B, Marques-Vidal P, Toriel J, Tobback N, Andries D, Preisig M, Vollenweider P, Postuma R, Heinzer R. Prevalence and determinants of rapid eye movement sleep behavior disorder in the general population. Sleep 2017; 41:4690595. [PMID: 29216391 DOI: 10.1093/sleep/zsx197] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia associated with neurodegenerative synucleinopathies. Its prevalence is largely unknown. This study determined the prevalence and characteristics of RBD in the general population using gold-standard polysomnography. METHODS Full polysomnographic data from 1,997 participants (age = 59 ± 11.1 years, 53.6% women) participating in a population-based study (HypnoLaus, Lausanne, Switzerland) were collected. Sleep-related complaints and habits were investigated using various sleep measures including the Munich Parasomnia Screening (MUPS) questionnaire, which includes two questions evaluating complex motor behaviors suggestive of RBD. Full polysomnography was performed at home. For participants screening positive for RBD, muscle activity during REM sleep was quantified to diagnose RBD. RESULTS Three hundred sixty-eight participants endorsed dream-enactment behavior on either of the two MUPS questions, and 21 fulfilled polysomnographic criteria for RBD, resulting in an estimated prevalence of 1.06% (95% CI = 0.61-1.50), with no difference between men and women. Compared with RBD- participants, RBD+ took more frequently antidepressants and antipsychotics (23.8% vs. 5.4%, p = .005; 14.3% vs. 1.5%, p = .004, respectively) and were more frequently smokers or ex-smokers (85% vs. 56.6%, p = .011). On polysomnography, RBD+ had more stage N2 sleep (52 ± 11.5% vs. 46.3 ± 10.2%, p = .024) and less REM sleep (18 ± 6.4% vs. 21.9 ± 6.2%, p = .007), lower apnea-hypopnea index in REM sleep (3.8 ± 5.2 vs. 8.9 ± 13/hour, p = .035), and lower autonomic arousal index (31 ± 14.9 vs. 42.6 ± 19.5/hour, p = .002). CONCLUSIONS In our middle-to-older age population-based sample, the prevalence of RBD was 1.06%, with no difference between men and women. RBD was associated with antidepressant and antipsychotic use and with minor differences in sleep structure.
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Affiliation(s)
- José Haba-Rubio
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Birgit Frauscher
- Department of Medicine and Center for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerl
| | - Jérôme Toriel
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Nadia Tobback
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Daniela Andries
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerl
| | - Ronald Postuma
- Department of Neurology, Montreal General Hospital, Montréal, Quebec, Canada
| | - Raphaël Heinzer
- Center for Investigation and Research in Sleep (CIRS), Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Department of Pulmonary Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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37
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Bargiotas P, Arnet I, Frei M, Baumann C, Schindler K, Bassetti C. Demographic, Clinical and Polysomnographic Characteristics of Childhood- and Adult-Onset Sleepwalking in Adults. Eur Neurol 2017; 78:307-311. [DOI: 10.1159/000481685] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/19/2017] [Indexed: 11/19/2022]
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38
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Heidbreder A, Stefani A, Brandauer E, Steiger R, Kremser C, Gizewski ER, Young P, Poewe W, Högl B, Scherfler C. Gray matter abnormalities of the dorsal posterior cingulate in sleep walking. Sleep Med 2017; 36:152-155. [DOI: 10.1016/j.sleep.2017.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 04/06/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
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Abstract
PURPOSE OF REVIEW Review of the literature pertaining to clinical presentation, classification, epidemiology, pathophysiology, diagnosis, and treatment of sleep-related movement disorders and disturbances of motor control. RECENT FINDINGS Sleep-related movement disorders and disturbances of motor control are typically characterized by positive motor symptoms and are often associated with sleep disturbances and consequent daytime symptoms (e.g. fatigue, sleepiness). They often represent the first or main manifestation of underlying disorders of the central nervous system, which require specific work-up and treatment. Diverse and often combined cause factors have been identified. Although recent data provide some evidence regarding abnormal activation and/or disinhibition of motor circuits during sleep, for the majority of these disorders the pathogenetic mechanisms remain speculative. The differential diagnosis is sometimes difficult and misdiagnoses are not infrequent. The diagnosis is based on clinical and video-polysomnographic findings. Treatment of sleep-related motor disturbances with few exceptions (e.g. restless legs/limbs syndrome) are based mainly on anecdotal reports or small series. SUMMARY More state-of-the-art studies on the cause, pathophysiology, and treatment of sleep-related movement disorders and disturbances of motor control are needed.
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40
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Castelnovo A, Riedner BA, Smith RF, Tononi G, Boly M, Benca RM. Scalp and Source Power Topography in Sleepwalking and Sleep Terrors: A High-Density EEG Study. Sleep 2016; 39:1815-1825. [PMID: 27568805 DOI: 10.5665/sleep.6162] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/06/2016] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To examine scalp and source power topography in sleep arousals disorders (SADs) using high-density EEG (hdEEG). METHODS Fifteen adult subjects with sleep arousal disorders (SADs) and 15 age- and gender-matched good sleeping healthy controls were recorded in a sleep laboratory setting using a 256 channel EEG system. RESULTS Scalp EEG analysis of all night NREM sleep revealed a localized decrease in slow wave activity (SWA) power (1-4 Hz) over centro-parietal regions relative to the rest of the brain in SADs compared to good sleeping healthy controls. Source modelling analysis of 5-minute segments taken from N3 during the first half of the night revealed that the local decrease in SWA power was prominent at the level of the cingulate, motor, and sensori-motor associative cortices. Similar patterns were also evident during REM sleep and wake. These differences in local sleep were present in the absence of any detectable clinical or electrophysiological sign of arousal. CONCLUSIONS Overall, results suggest the presence of local sleep differences in the brain of SADs patients during nights without clinical episodes. The persistence of similar topographical changes in local EEG power during REM sleep and wakefulness points to trait-like functional changes that cross the boundaries of NREM sleep. The regions identified by source imaging are consistent with the current neurophysiological understanding of SADs as a disorder caused by local arousals in motor and cingulate cortices. Persistent localized changes in neuronal excitability may predispose affected subjects to clinical episodes.
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Affiliation(s)
- Anna Castelnovo
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison WI
| | - Brady A Riedner
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison WI
| | - Richard F Smith
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison WI
| | - Giulio Tononi
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison WI
| | - Melanie Boly
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison WI
| | - Ruth M Benca
- University of Wisconsin School of Medicine and Public Health, Department of Psychiatry, Madison WI
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41
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Horváth A, Papp A, Szűcs A. Progress in elucidating the pathophysiological basis of nonrapid eye movement parasomnias: not yet informing therapeutic strategies. Nat Sci Sleep 2016; 8:73-9. [PMID: 27022307 PMCID: PMC4790540 DOI: 10.2147/nss.s71513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nonrapid eye movement (NREM) or arousal parasomnias are prevalent conditions in children and young adults, apparently provoked by any medical, physical, mental, or pharmacologic/toxic agent disturbing normal biorhythm and causing sleep fragmentation or abundant amount of slow wave sleep. The nadir and the ascending slope of the first sleep cycle of night sleep are the typical periods when NREM parasomnias, especially sleepwalking may occur on sleep-microstructural level; microarousals are the typical moments allowing NREM parasomnias. While sleep-disturbing factors have a clear precipitating effect, a genetic predisposition appears necessary in most cases. A candidate gene for sleepwalking has been identified on chromosome 20q12-q13.12 in one sleepwalking family. NREM parasomnias have a genetic and clinical link with nocturnal-frontal lobe epilepsies; possibly through an abnormality of the acetylcholine-related sleep-control system. The association of NREM parasomnias with the human leukocyte antigen system might be the sign of an autoimmune background to be further clarified. In the treatment of arousal parasomnias, the main tools are adequate sleep hygiene and the management of underlying conditions. Their pharmacotherapy has remained unresolved; the best options are clonazepam and some of the antidepressants, while a psychotherapy approach is also justified.
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Affiliation(s)
- András Horváth
- Department of Neurology, National Institute of Clinical Neurosciences, Semmelweis University School of PhD Studies, Budapest, Hungary
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University School of PhD Studies, Budapest, Hungary
| | - Anikó Papp
- Department of Neurology, National Institute of Clinical Neurosciences, Semmelweis University School of PhD Studies, Budapest, Hungary
| | - Anna Szűcs
- Department of Neurology, National Institute of Clinical Neurosciences, Semmelweis University School of PhD Studies, Budapest, Hungary
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42
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Lee HG, Choi JW, Lee YJ, Jeong DU. Depressed REM Sleep Behavior Disorder Patients Are Less Likely to Recall Enacted Dreams than Non-Depressed Ones. Psychiatry Investig 2016; 13:227-31. [PMID: 27081385 PMCID: PMC4823200 DOI: 10.4306/pi.2016.13.2.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE REM sleep behavior disorder (RBD) is associated with psychiatric symptoms, such as anxiety and alexithymia. However, only a few studies on the relationship between depression and RBD have been published. In this study, we investigated the occurrence of depression and associated factors in patients with RBD. METHODS In total 94 patients (mean age: 61.9±12.7 years, male: 70.2%) diagnosed as RBD were examined using detailed clinical histories, the Beck Depression Inventory (BDI), the Epworth Sleepiness Scale (ESS), and nocturnal polysomnography (PSG). RESULTS The mean BDI score of all patients was 12.4±10.3 and 44.7% of RBD patients showed depressed mood (BDI >11 points). Depressed RBD patients were less able to recall enacted dreams than were non-depressed patients (61.9% vs. 86.5%, p=0.008). Logistic regression analysis showed that failure to recall enacted dreams was significantly associated with depression, after controlling for confounding variables including the respiratory disturbance index and a history of psychiatric disorders (odds ratio=0.323, p=0.041). CONCLUSION In this study, 44.7% of RBD patients were found to suffer from depressed mood. And, depression was found to be associated with reduced ability to recall enacted dreams. We suggest that routine evaluation of depression be performed in RBD patients, particularly when failure to recall enacted dreams is evident. We speculate that such failure may be associated with emotional dysregulation or neurodegeneration.
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Affiliation(s)
- Hyeong Gon Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Won Choi
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Un Jeong
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
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43
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Dossey L. Sleep Violence. Explore (NY) 2015; 11:421-6. [PMID: 26433777 DOI: 10.1016/j.explore.2015.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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44
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Bassetti CL, Ferini-Strambi L, Brown S, Adamantidis A, Benedetti F, Bruni O, Cajochen C, Dolenc-Groselj L, Ferri R, Gais S, Huber R, Khatami R, Lammers GJ, Luppi PH, Manconi M, Nissen C, Nobili L, Peigneux P, Pollmächer T, Randerath W, Riemann D, Santamaria J, Schindler K, Tafti M, Van Someren E, Wetter TC. Neurology and psychiatry: waking up to opportunities of sleep. : State of the art and clinical/research priorities for the next decade. Eur J Neurol 2015; 22:1337-54. [DOI: 10.1111/ene.12781] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/05/2015] [Indexed: 12/22/2022]
Affiliation(s)
- C. L. Bassetti
- Department of Neurology; Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - L. Ferini-Strambi
- Division of Neuroscience; Sleep Disorders Centre; Università Vita-Salute San Raffaele; Milan Italy
| | - S. Brown
- Institute of Pharmacology and Toxicology; University of Zürich; Zürich Switzerland
| | - A. Adamantidis
- Department of Neurology; Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - F. Benedetti
- Department of Clinical Neurosciences; Scientific Institute and University Vita-Salute San Raffaele; Milan Italy
| | - O. Bruni
- Department of Developmental and Social Psychology; Sapienza University; Rome Italy
| | - C. Cajochen
- Psychiatric University Clinic; Basel Switzerland
| | - L. Dolenc-Groselj
- Division of Neurology; Institute of Clinical Neurophysiology; University Medical Centre Ljubljana; Ljubljana Slovenia
| | - R. Ferri
- Department of Neurology; Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS); Troina Italy
| | - S. Gais
- Medical Psychology and Behavioural Neurobiology; Eberhard Karls Universität Tübingen; Tübingen Germany
| | - R. Huber
- Department of Paediatrics; Children's University Hospital; Zurich Switzerland
| | - R. Khatami
- Sleep Centre; Klinik Barmelweid AG; Barmelweid Switzerland
| | - G. J. Lammers
- Department of Neurology and Clinical Neurophysiology; Leiden University Medical Centre; Leiden The Netherlands
- Sleep Wake Centre SEIN; Stichting Epilepsie Instellingen Nederland; Heemstede The Netherlands
| | - P. H. Luppi
- UMR 5292 CNRS/U1028 INSERM; Centre de Recherche en Neurosciences de Lyon (CRNL); Team “Physiopathologie des réseaux neuronaux responsables du cycle veille-sommeil”; Université Claude Bernard Lyon I; Lyon France
| | - M. Manconi
- Sleep and Epilepsy Centre; Neurocentre of Southern Switzerland; Civic Hospital (EOC) of Lugano; Lugano Switzerland
| | - C. Nissen
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Centre for Mental Disorders; Freiburg University Medical Centre; Freiburg Germany
| | - L. Nobili
- Centre of Epilepsy Surgery ‘C. Munari’; Niguarda Hospital; Milan Italy
| | - P. Peigneux
- UR2NF - Neuropsychology and Functional Neuroimaging Research Unit; CRCN - Centre de Recherches Cognition et Neurosciences and UNI - ULB Neurosciences Institute; Université Libre de Bruxelles (ULB); Brussels Belgium
| | - T. Pollmächer
- Center of Mental Health; Klinikum Ingolstadt; Ingolstadt Germany
| | - W. Randerath
- Institut für Pneumologie; Krankenhaus Bethanien gGmbH; Universität Witten/Herdecke; Solingen Germany
| | - D. Riemann
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine; Centre for Mental Disorders; Freiburg University Medical Centre; Freiburg Germany
| | - J. Santamaria
- Neurology Service; Hospital Clínic of Barcelona; Institut d'Investigació Biomèdiques August Pi i Sunyer (IDIBAPS); Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED); Barcelona Spain
| | - K. Schindler
- Department of Neurology; Inselspital, Bern University Hospital; University of Bern; Bern Switzerland
| | - M. Tafti
- Centre for Integrative Genomics; University of Lausanne; Lausanne Switzerland
- Centre for Investigation and Research in Sleep; Vaud University Hospital; Lausanne Switzerland
| | - E. Van Someren
- Department of Sleep and Cognition; Netherlands Institute for Neuroscience; Amsterdam The Netherlands
- Departments of Integrative Neurophysiology and Medical Psychology; Center for Neurogenomics and Cognitive Research (CNCR); VU University and Medical Center; Amsterdam The Netherlands
| | - T. C. Wetter
- Department of Psychiatry and Psychotherapy; University of Regensburg; Regensburg Germany
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Bušková J, Piško J, Pastorek L, Šonka K. The course and character of sleepwalking in adulthood: a clinical and polysomnographic study. Behav Sleep Med 2015; 13:169-77. [PMID: 24597508 DOI: 10.1080/15402002.2013.845783] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To describe characteristics of adult sleepwalking (potential triggers and correlates with polysomnography), 52 patients were interviewed regarding their sleepwalking episodes and underwent video-polysomnography on two consecutive nights. Sleepwalking history averaged 12 years and frequent episodes (more than once per week) occurred in 62%. Higher frequency was associated with earlier onset of sleepwalking (p < 0.005) and 53.8% reported dangerous sleepwalking behavior. The most common self-reported triggers were sleep deprivation and stressful events, while no specific trigger was reported in 37% of patients. More awakening from slow-wave sleep was associated with a higher frequency of sleepwalking episodes (p < 0.001). A longer history of sleepwalking was associated with more sleepwalking episodes, even without the presence of sleep comorbidities or other known precipitating factors.
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Affiliation(s)
- Jitka Bušková
- a Sleep Disorders Center, Department of Neurology and Center of Clinical Neuroscience First Faculty of Medicine Charles University , Prague
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Popat S, Winslade W. While You Were Sleepwalking: Science and Neurobiology of Sleep Disorders & the Enigma of Legal Responsibility of Violence During Parasomnia. NEUROETHICS-NETH 2015. [PMID: 26203309 PMCID: PMC4506454 DOI: 10.1007/s12152-015-9229-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In terms of medical science and legal responsibility, the sleep disorder category of parasomnias, chiefly REM sleep behavior disorder and somnambulism, pose an enigmatic dilemma. During an episode of parasomnia, individuals are neither awake nor aware, but their actions appear conscious. As these actions move beyond the innocuous, such as eating and blurting out embarrassing information, and enter the realm of rape and homicide, their degree of importance and relevance increases exponentially. Parasomnias that result in illegal activity, particularly violence, are puzzling phenomena for medicine and the law. Via a review of the pertinent medical literature, a general overview of the current scientific knowledge of parasomnias will be provided. Though this knowledge is far from complete, it can provide some neurobiological information about the nature of parasomnia, including conclusions about a sleepwalker's level of intention as well as factors that predispose one to such episodes. Although a parasomniac's complete lack of consciousness warrants acquittal from criminal liability, it does not exclude responsibility for subjecting oneself to exacerbating factors that result in these violent parasomnias. Individuals should be held accountable if they could be expected to control these factors. In addition, they should undergo appropriate treatment and management in order to prevent future parasomnia behaviors. Establishing a legal defense for parasomnia will prove difficult due to the strong potential for malingering, so specific criteria will be outlined in order to distinguish between true and fraudulent claims of crimes committed during parasomniac states.
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Affiliation(s)
- Shreeya Popat
- The University of Texas Southwestern Medical School, Dallas, TX USA ; Plan II Honors Program, The University of Texas, Austin, TX USA
| | - William Winslade
- Plan II Honors Program, The University of Texas, Austin, TX USA ; The Institute for the Medical Humanities, The University of Texas Medical Branch, Galveston, TX USA
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Ingravallo F, Poli F, Gilmore EV, Pizza F, Vignatelli L, Schenck CH, Plazzi G. Sleep-related violence and sexual behavior in sleep: a systematic review of medical-legal case reports. J Clin Sleep Med 2014; 10:927-35. [PMID: 25126042 DOI: 10.5664/jcsm.3976] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To review systematically medical-legal cases of sleep-related violence (SRV) and sexual behavior in sleep (SBS). SEARCH METHODS We searched Pubmed and PsychINFO (from 1980 to 2012) with pre-specified terms. We also searched reference lists of relevant articles. SELECTION CRITERIA Case reports in which a sleep disorder was purported as the defense during a criminal trial and in which information about the forensic evaluation of the defendant was provided. DATA EXTRACTION AND ANALYSIS Information about legal issues, defendant and victim characteristics, circumstantial factors, and forensic evaluation was extracted from each case. A qualitative-comparative assessment of cases was performed. RESULTS Eighteen cases (9 SRV and 9 SBS) were included. The charge was murder or attempted murder in all SRV cases, while in SBS cases the charge ranged from sexual touching to rape. The defense was based on sleepwalking in 11 of 18 cases. The trial outcome was in favor of the defendant in 14 of 18 cases. Defendants were relatively young males in all cases. Victims were usually adult relatives of the defendants in SRV cases and unrelated young girls or adolescents in SBS cases. In most cases the criminal events occurred 1-2 hours after the defendant's sleep onset, and both proximity and other potential triggering factors were reported. The forensic evaluations widely differed from case to case. CONCLUSION SRV and SBS medical-legal cases did not show apparent differences, except for the severity of the charges and the victim characteristics. An international multidisciplinary consensus for the forensic evaluation of SRV and SBS should be developed as an urgent priority.
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Affiliation(s)
- Francesca Ingravallo
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesca Poli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Emma V Gilmore
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Pizza
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; ; IRRCS Institute of Neurological Sciences, Bologna, Italy
| | | | - Carlos H Schenck
- University of Minnesota, Minnesota Regional Sleep Disorders Centre, Minneapolis, MN
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; ; IRRCS Institute of Neurological Sciences, Bologna, Italy
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Abstract
The military population is particularly vulnerable to a multitude of sleep-related disorders owing to the type of work performed by active duty servicemembers (ADSMs). Inadequate sleep, due to insufficient quantity or quality, is increasingly recognized as a public health concern. Traditionally, ADSMs have been encouraged that they can adapt to insufficient sleep just as the body adapts to physical training, but there is a substantial body of scientific literature which argues that this is not possible. Additionally, the military work environment creates unique challenges with respect to treatment options for common sleep disorders like obstructive sleep apnea, restless legs syndrome, and parasomnias. This review highlights sleep disorders which are prevalent in the modern military force and discusses the impact of poor sleep on overall performance. Medical treatments and recommendations for unit leaders are also discussed.
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Stores G. Psychological disturbance associated with recurrent abnormal nocturnal events. Br J Hosp Med (Lond) 2014; 75:337-41. [PMID: 25040410 DOI: 10.12968/hmed.2014.75.6.337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gregory Stores
- Emeritus Professor of Developmental Neuropsychiatry in the Department of Psychiatry, University of Oxford, Oxford
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50
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Violent somnambulism: A parasomnia of young men with stereotyped dream-like experiences. Med Hypotheses 2014; 83:47-52. [DOI: 10.1016/j.mehy.2014.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 03/28/2014] [Accepted: 04/06/2014] [Indexed: 12/30/2022]
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